Are Fibroids Causing Your Pelvic Pain? A Surgeon Explains
Fibroids can genuinely cause pain, through degeneration or pressure on nearby structures, but they're also frequently found alongside endometriosis or adenomyosis, conditions that don't show up as clearly on imaging. Dr. Murphy explains why a thorough evaluation (not just a scan) matters before assuming fibroids are the whole story, since that distinction is central to real informed consent.
“Are my fibroids the cause of my pelvic pain?” It’s one of the most common questions Dr. Latasha Murphy, gynecologic surgeon at PRM Baltimore, hears from patients — and the honest answer is: maybe.
That “maybe” matters more than it might seem. In a field where fibroids are often treated as an automatic explanation for pelvic pain, understanding when they actually are the cause — and when something else deserves equal attention — is central to getting the right treatment the first time.
Uterine fibroids can absolutely be a genuine source of pelvic pain, and there are a few specific ways that happens:
Degeneration. Fibroids sometimes outgrow their own blood supply, causing parts of the tissue to break down. That process is often inflammatory and can be acutely painful — a phenomenon known as fibroid degeneration.
Mass effect. When fibroids grow large enough, they can press on surrounding structures — the bladder, the bowel, blood vessels, or pelvic nerves. That pressure can produce pain, along with symptoms like urinary frequency, constipation, or a persistent feeling of pelvic pressure or fullness.
Both of these are legitimate, well-understood mechanisms by which fibroids cause pain. The complication is that they’re not the only possible explanation — and fibroids have a habit of getting more credit than they deserve.
Here’s the piece that doesn’t get discussed enough: fibroids are easy to see. A routine ultrasound or MRI will typically identify them clearly. Endometriosis and adenomyosis, on the other hand, are notoriously difficult to identify on standard imaging — sometimes missed entirely, even when they’re actively contributing to a patient’s symptoms.
That imaging gap creates a real clinical risk. If a scan shows fibroids and a patient has pelvic pain, it’s easy — but not necessarily accurate — to conclude the fibroids are the whole story. Fibroids frequently coexist with endometriosis and adenomyosis, and when they do, treating the fibroids alone may leave a significant source of pain completely unaddressed.
According to Dr. Murphy, this is exactly why a thorough evaluation matters before assuming fibroids are the sole cause of pelvic pain: making sure the possibility of coexisting endometriosis or adenomyosis has genuinely been ruled out, not just overlooked because fibroids were the easier finding.
This distinction isn’t just clinically important — it’s central to what informed consent actually requires. A patient can’t meaningfully weigh her treatment options if the diagnosis itself is incomplete. If fibroids are treated as the default explanation without ruling out endometriosis or adenomyosis, a patient may consent to a procedure that addresses only part of what’s actually causing her pain — or overlook less invasive options that might have been appropriate for her full clinical picture.
At PRM, this is a big part of what a thorough evaluation is built to catch — not just confirming what’s visible on imaging, but actively investigating what might not be.
Getting a complete picture typically means:
Fibroids can absolutely cause pelvic pain – but “I have fibroids and I have pelvic pain” isn’t automatically the same as “my fibroids are causing my pelvic pain.” Getting that distinction right is what separates a treatment plan that actually works from one that treats only part of the problem.
If you’ve been told your fibroids are the explanation for your pain and something still doesn’t add up, that’s worth a second look.
No. If fibroids aren’t causing symptoms, monitoring is a reasonable approach. Treatment becomes necessary when fibroids are driving real problems like heavy bleeding, pain, or fertility issues.
Fibroids have a distinct, solid structure that’s typically easy to identify on ultrasound or MRI. Endometriosis and adenomyosis involve more subtle tissue changes that can be missed even on imaging, especially without a specialist reviewing the scan specifically for those conditions.
Yes. These conditions frequently coexist, and having one doesn’t rule out the other.
A detailed symptom history, imaging interpreted in the context of your full symptom picture (not just what’s visible), a physical exam, and a conversation about your fertility goals and treatment preferences.
There’s real value in it, but strict elimination diets aren’t necessary for everyone. A more sustainable approach is moderation — noticing which foods affect your symptoms and adjusting portions or frequency, rather than cutting entire food groups without a plan.
It may mean another condition, like endometriosis or adenomyosis, was contributing to your pain and wasn’t addressed. That’s worth bringing back to your provider for further evaluation.
